Protection Against Cold in Prehospital Care: Wet Clothing Removal or Addition of a Vapor Barrier

Henriksson, Otto; Lundgren, Peter; Kuklane, Kalev; Holmér, Ingvar; Giesbrecht, Gordon G.; Naredi, Peter; Björnstig, Ulf

doi:10.1016/j.wem.2014.07.001

Cited by 35 publications

(29 citation statements)

References 33 publications

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“…Suffering and relief of suffering. Patients suffering from cold exposure were studied in relation to low temperatures in the prehospital environment (75)(76)(77). In the ambulance, 85% of the patients had a finger temperature below comfort zone and 44% experienced the ambient temperature in the ambulance as cold (75).…”

Section: Life-changing Situationsmentioning

confidence: 99%

Caring science research in the ambulance services: an integrative systematic review

Sundström

Bremer

Lindström

et al. 2018

Scandinavian Caring Sciences

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Background The ambulance services are associated with emergency medicine, traumatology and disaster medicine, which is also reflected in previous research. Caring science research is limited and, since no systematic reviews have yet been produced, its focus is unclear. This makes it difficult for researchers to identify current knowledge gaps and clinicians to implement research findings. Aim This integrative systematic review aims to describe caring science research content and scope in the ambulance services. Data sources Databases included were MEDLINE (PubMed), CINAHL, Web of Science, ProQDiss, LibrisDiss and The Cochrane Library. The electronic search strategy was carried out between March and April 2015. The review was conducted in line with the standards of the PRISMA statement, registration number: PROSPERO 2016:CRD42016034156. Review methods The review process involved problem identification, literature search, data evaluation, data analysis and reporting. Thematic data analysis was undertaken using a five‐stage method. Studies included were evaluated with methodological and/or theoretical rigour on a 3‐level scale, and data relevance was evaluated on a 2‐level scale. Results After the screening process, a total of 78 studies were included. The majority of these were conducted in Sweden (n = 42), fourteen in the United States and eleven in the United Kingdom. The number of study participants varied, from a case study with one participant to a survey with 2420 participants, and 28 (36%) of the studies were directly related to patients. The findings were identified under the themes: Caregiving in unpredictable situations; Independent and shared decision‐making; Public environment and patient safety; Life‐changing situations; and Ethics and values. Conclusion Caring science research with an explicit patient perspective is limited. Areas of particular interest for future research are the impact of unpredictable encounters on openness and sensitivity in the professional–patient relation, with special focus on value conflicts in emergency situations.

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Section: Life-changing Situationsmentioning

confidence: 99%

Caring science research in the ambulance services: an integrative systematic review

Sundström

Bremer

Lindström

et al. 2018

Scandinavian Caring Sciences

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“…Consensus guidance, supported by recent studies, have suggested that the use of vapour-tight layers to reduce evaporative heat loss may negate the need to remove wet clothing 23. This could be highly beneficial, as the removal of wet clothing exposes the casualty to a cold environment and risks reducing core temperature further.…”

Section: Discussionmentioning

confidence: 99%

“…This could be highly beneficial, as the removal of wet clothing exposes the casualty to a cold environment and risks reducing core temperature further. It is worth noting that studies comparing removal of wet clothes with using a vapour-tight layer have so far used small sample sizes in laboratory conditions and showed limited effect 23. Further research is therefore warranted in this topic.…”

Section: Discussionmentioning

confidence: 99%

Managing accidental hypothermia: a UK-wide survey of prehospital and search and rescue providers

et al. 2018

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“…Our study only examined the ability of a given system to insulate a water-filled manikin under dry, still-air conditions. It did not consider other potentially useful features of such simple equipment including the fact that, in a casualty still able to generate heat, the plastic survival bag would act as a vapour barrier thereby possibly preventing further wetting and reduce some wind-induced convective heat loss [22, 23]. Indeed, while this paper was being peer-reviewed, an anecdotal account from Cairngorm Mountain Rescue Team, Scotland and reported by the BBC, attributed the survival of two benighted hillwalkers on the blizzard-swept Cairngorm plateau to the use of such a plastic bag [25].…”

Section: Discussionmentioning

confidence: 99%

Measurements of rates of cooling of a manikin insulated with different mountain rescue casualty bags

et al. 2017

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BackgroundAccidental hypothermia is common in those who sustain injuries in remote environments. This is unpleasant and associated with adverse effects on subsequent patient outcomes. To minimise further heat loss, a range of insulating systems are available to mountain rescue teams although the most effective and cost-efficient have yet to be determined.MethodsUnder ambient, still, dry, air conditions, a thermal manikin was filled with water at a temperature of 42 °C and then placed into a given insulation system. Water temperature was then continuously observed via an in-dwelling temperature sensor linked to a PROPAQ 100 series monitor and recorded every 10 min for 130 min. This method was repeated for each insulating package.ResultsThe vacuum mattress/Pertex©/fibrepile blanket system, either on its own or coupled with the Wiggy bag, was the most efficient with water temperatures only decreasing by 3.2 °C over 130 min. This was followed by the heavy-weight casualty bags without the vacuum mattress/Pertex©/fibrepile blanket system, decreasing by 4.2–4.3 °C. With the Blizzard bag, a decline in water temperature of 5.4 °C was seen over the study duration while a decrease of 9.5 °C was noted when the plastic survival bag was employed.ConclusionsUnder the still-air conditions of the study, the vacuum mattress/Pertex©/fibrepile blanket was seen to offer comparable insulation effectiveness compared to be both heavy-weight casualty bags. In turn, these three systems appeared more efficient at insulating the manikin than the Blizzard bag or plastic survival bag.Electronic supplementary materialThe online version of this article (doi:10.1186/s13728-017-0055-7) contains supplementary material, which is available to authorised users.

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Protection Against Cold in Prehospital Care: Wet Clothing Removal or Addition of a Vapor Barrier

Abstract: In protracted rescue scenarios in cold environments with only limited insulation available, wet clothing removal or the use of a vapor barrier is advocated to limit the need for shivering thermogenesis and improve the patient's condition on admission to the emergency department.

Cited by 35 publications

References 33 publications

Caring science research in the ambulance services: an integrative systematic review

Caring science research in the ambulance services: an integrative systematic review

Managing accidental hypothermia: a UK-wide survey of prehospital and search and rescue providers

Measurements of rates of cooling of a manikin insulated with different mountain rescue casualty bags

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